MEDICARE: JORDAN FELDMANN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor		OK
2	101YP2500X	Professional Counselor	6991	OK

General Provider Information

NPI Number	:	1780131847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN FELDMANN

Provider Business Mailing Address
First Line	:	14621 EXMOOR CIR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73142-7814
Country	:	US
Telephone Number	:	972-786-1806
Fax Number	:

Provider Business Practice Location Address
First Line	:	6715 N MAY AVE STE 102
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-3422
Country	:	US
Telephone Number	:	405-418-7574
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2016
Last Update Date	:	04/18/2022

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